Social Determinants of Childhood Obesity for Asian Americans/ Southeast Asians

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Social Determinants of Childhood Obesity for
Asian Americans/ Southeast Asians

• Tu-Uyen Ngoc Nguyen, Ph.D., M.P.H
• HESC 475 Guest Lecture
• Week 10 Oct. 29th

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Learning Objectives

• 1) Outline API diversity - fastest growth rate,
  majority are immigrants. 
• 2) Introduce "model minority" concept - effects
  on public perceptions of API health
• 3) Outline traditional Southeast Asian health
  practices
• yin/yang concept, coining, cupping, use of
  medicinal herbs
• 4) Outline differences between Southeast Asian
  communities
• culture, immigrant vs. refugee experiences,
  geography, SES, health
• 5) Introduce Social-Ecological Model use in
  developing effective obesity prevention programs
  for Southeast Asian communities.
• 6) Discuss physical activity/ nutrition programs/
  interventions in SEA communities

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AAPI Health Disparities

• 1) Rapid population growth
• 2) Model minority myth
• 3) Inadequate data on health of AAPIs (paucity
  of data - inadequate sample size),
  misclassification of data, lack of disaggregated
  ethnic specific data
• 4) Lack of resources

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API Model Minority Images
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From 1992 to 2001, Overweight Increased Most
Sharply for California API Low-Income Children,
Increasing 127 from 5.9 to 13.4
Percent change of overweight, low-income CA
children
Overweight BMI gt 95th percentile. Overweight
is comparable to obesity in adults. Children 5
- gt20 years old Source California Dept. of
Health Services, Childrens Medical Services
Branch, California Pediatric Nutrition
Surveillance System
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Southeast AsiaCambodia Laos Thailand
Vietnam
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Who are Southeast Asian Refugees?

• Cambodian (Khmer)
• Laotians (over 60 different ethnic groups)
• Hmong
• Khmu
• Mien
• Vietnamese (over 50 different ethnic groups)
• Others displaced and forced to flee from their
  homelands because of the Vietnam/ American War

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Cultural Concepts of Health, Disease, Illness

• YIN/YANG Concept
• Two opposing forces must be in balance to
  maintain good health.
• There are no good or bad foods just foods
  that have hot and cold properties and are in
  eaten in balance, depending on state of health.
• COINING
• A traditional Southeast Asian folk treatment in
  which a coin is dipped in a mentholated liquid
  and rubbed vigorously over sections of skin on
  the body.
• CUPPING/ MOXIBUSTION
• Heated glass vials are placed on the skin,
  creating a suction when they cool.
• MEDICINAL HERBS

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THE HEALTH STATUS OF AAPIs Obesity by
Acculturation

• Impact on Children is Hardest
• Among immigrant API ? number of years in the US
  ? weight.
• Obesity ? x2 from first to second generation AA
  adolescents.
• Asian children born outside the U.S. have less
  obesity than those born in US of immigrant
  parents.
• 1996 Medical Expenditure Survey shows Latino and
  API adolescents more overweight.
• Obese children who grow into obese adults live 10
  20 fewer years

Haas JS, American Journal of Public Health,
2003 Popkin BM, American Society for Nutritional
Sciences, 1997
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Obesity is increasing problem in AAPI Communities
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Social Ecological Model/ Perspective

• The Social Ecological perspective is a
  multi-level, dynamic inter-disciplinary
  approach to understanding how health issues are
  influenced by 5 interacting levels
• Intrapersonal or Individual factors
• Interpersonal or Family factors
• Organizational or Institutional factors
• Community factors
• Public Policy factors
• McLeroy et al., 1988.

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Applying the Social Ecological Perspective to
Obesity Prevention

• Example Increasing Physical Activity
• Intrapersonal/Individual Factors Knowledge,
  beliefs, attitudes, practices on nutrition
  physical activity
• Interpersonal Factors Family/ Provider support
  for physical activity Social networks enabling
  physical activity
• Institutional/Organizational Factors
  Availability - Interpretation culturally
  competent health services provided by places of
  care (e.g. clinics, hospitals, community-based
  organizations CBOs) Accountability - Follow-up
  treatment Accessibility Work hours,
  Transportation
• Community Factors Acceptability - Community
  norms for physical activity Feelings of
  discrimination/ racism
• Public Policy Factors Affordability of services
  Insurance coverage policies free/low cost
  programs

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UCLA Case Study Research on Five a Day Campaign
in 3 Asian Communities

• Explored knowledge, attitudes, opinions and
  reported behavior
• health and healthy lifestyles
• dietary practices
• fruit and vegetable consumption
• physical activity
• Among 3 low-income Asian-American ethnic groups
  in CA
• Chinese, Hmong, Vietnamese
• Reported findings and recommendations to DHS/CPNS
  for formal presentation at the 2004 Sacramento
  AANCART Academy
• Harrison et. al. Seizing the Moment (2005).
  Cancer Supplement 104(12)2962-2968

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Community Partners
UC Extension, Berkeley
Hmong Womens Heritage Association
Kai Ming Head Start
Stone Soup
Chinatown Service Center
Vietnamese American Cancer Foundation
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Sample Selection Criteria

• Ethnicity Chinese, Hmong, and
• Vietnamese
• Poverty Below 185 federal poverty level
• Sites Los Angeles, San Francisco, Fresno,
  
• Sacramento, Elk Grove, Little
  Saigon,
• San Jose
• Participants

116 Adult FG Participants, age 25-80 105 Youth
FG Participants, age 11-14 15 Key Informants,
age 25-62 236 Total
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Common Health Beliefs of Chinese, Hmong and
Vietnamese

• Importance of FV consumption and PA for general
  health
• Health includes concept of harmonious family and
  balance
• Healthy foods fresh foods pesticide-free,
  recently picked/slaughtered, hormone-free,
  non-frozen, not canned
• Concept of warm and cool foods
• Home-cooked meals healthier than eating out

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Two overall goals for campaign from CAANPAC
findings

• Maintenance of cultural
• integrity and pride
• 2) Necessity of cultural tailoring

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Ways to Encourage/Maintain

• F V Consumption
• Commonalities
• Highlight importance of eating
• FV daily
• Creative cooking to include FV in
• every meal
• Educate parents and children about proper
  nutrition and
• benefits of FV
• Have family dinners create positive eating
• environment
• Parents serve as role models
• Purchase/serve more FV
• Teach children at an early age to eat FV

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Ways to Encourage/Maintain- Individual Level of
Health

• Physical Activity
• All groups agreed
• Reinforce tradition of family activities with
• children
• Provide low-cost or free supervised physical
• activities in the community
• Improve access to parks and playgrounds

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Common Strategies and Suggestions-Group Level

• Educational Materials/Workshops Classes
• In-language materials
• Visual pamphlets, stickers, health videos,
• posters, book covers, key chains
• Audio Radio, incorporate music/jingle
• More pictures, less words
• Educational classes
• Locations for Education/Outreach
• Churches/temples
• Community-based agencies
• Doctors offices/clinics
• Health fairs
• Asian Supermarkets
• Schools

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Strategies and Suggestions- Community Level

• Media
• COMMON
• In-language TV and radio
• Parents commercials/PSAs between 6pm-8pm
• Use networks/programs children enjoy watching
  (e.g. cartoons)
• Shock campaigns (e.g. Truth.com)
• Using animation, celebrities, and/or athletes to
  market the message (e.g. Got Milk?)
• Billboards and signs also mentioned
• CULTURE SPECIFIC
• Chinese In language newspapers
• Hmong In language health videos
• Vietnamese In language TV and radio

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Strategies and Suggestions

• Health Information Messengers
• COMMON
• Parents (mothers)
• Teachers
• Community health outreach worker/social workers
• Community/religious leaders
• Doctors, Nurses, Nutritionists, Health educators
• CULTURE SPECIFIC
• Chinese Celebrities and Athletes
• Hmong Counselors, Friends/Peers
• Chinese Hmong PTA

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Maintenance of cultural integrity and pride

• Need Knowledge of benefits of traditional
  cultural activities, foods and family practices
  to pass on to their children
• Need knowledge of healthy mainstream American
  foods, sports and family expectations
• Lack of time ? default of convenience of American
  style meals and foods
• Children preferred (enjoyed) traditional foods
  and family time
• Blending of traditional and American style foods
  congee and hot dogs, Shalom Shanghai

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What can we do to improve our individual and
community health?
Community Advocacy
Healthy Diet
Exercise
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Conclusions
With greater numbers of years in the US,
traditional diets will inevitably include more
Western foods. Helping our children become
healthy adults means eating wisely and
maintaining physically active lives.